Are doctors really that important?

There’s been a lot of criticism of the individual market recently. The premiums are out of control, some say, and others complain about the narrow-network HMO plans with no out-of-network options. While it is true that people with chronic conditions who visit a number of doctors aren’t at all happy with the recent developments, it’s equally true that not everybody has such strong ties to a particular provider.

If you’ve been shying away from the individual market because you thought nobody would buy a watered-down plan with a skinny provider network, think again. Demand for individual plans was so high in mid-December that the government made the decision to extend the January 1st enrollment deadline by a couple days, and there are a lot of people who aren’t as disturbed by the recent trends in both premiums and plan designs as most brokers seem to be.

Here are a few things to consider as we head into the last month of the 2016 open enrollment period.

1) Not everyone pays full price

Millions of people qualify for a premium tax credit, and the majority of people purchasing coverage through the Marketplace are receiving some sort of financial assistance. So maybe you should focus on those people. That at least solves the premium issue. As for the high out-of-pocket costs, people who earn less than 250% of the federal poverty level also qualify for a cost-sharing subsidy, so their out-of-pocket exposure is significantly lower.

2) Not everyone has a doctor

A lot of people are reasonably healthy and don’t have a preferred provider. Others have been uninsured for years and don’t go to the doctor very often. Either way, these individuals don’t mind being restricted to a network in which they have to choose a primary care physician or get referrals to see a specialist; in fact, they may appreciate having a primary doctor and getting some help picking out a specialist when they need to see one.

3) Not everyone is attached to their doctor

Even people who have a family doctor may be willing to change. A lot of doctors rely on physician assistants or nurse practitioners to handle many of the routine visits in their office, which means that some patients don’t get to establish a relationship with the doctor and may not be that loyal if it means paying a higher premium to keep seeing him or her. The growth in urgent care centers, retail clinics, and telehealth provides further evidence that people are willing to seek care from someone other than the doctor that they’ve been seeing for years.

4) For some people, their doctors are in the network

It’s true! All of the doctors who participate in the more restrictive networks that are dominating the Marketplace actually have current patients, and any of those patients might be a good prospect. In fact, wanting to make sure they can continue to treat their existing patients, some doctors might even refer business to you if you can help make sure the patients end up with a plan that includes that provider.

5) You don’t even have to have “the talk” with your prospects

The beauty of a private exchange or online marketplace is that someone else will have the conversation about premiums, plan design, and provider networks for you, and you’ll still receive a portion of the commission. This allows you to spend your time drumming up leads rather than digging through provider directories. Doesn’t that sound like more fun? To learn more about private exchanges, click here.

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